As marijuana use increases globally, understanding its cardiovascular impact is crucial. This study investigates the relationship between marijuana use patterns and coronary heart disease (CHD) risk.
Methods
Using 2023 Behavioral Risk Factor Surveillance System data, we conducted cross-sectional analysis examining marijuana consumption methods (smoking, vaping, eating, dabbing) and CHD risk. Multivariable logistic regression assessed associations while controlling for demographic variables and established cardiovascular risk factors.
Results
Significant associations emerged between various marijuana consumption methods and increased CHD risk. Individuals engaging in both smoking and vaping showed significantly higher CHD risk. Combined consumption methods, particularly smoking and eating, further compounded risk among those with pre-existing cardiovascular risk factors. Traditional risk factors including hypertension, diabetes, and obesity remained critical CHD predictors.
Conclusion
This study reveals complex relationships between marijuana use patterns and CHD risk, emphasizing the need for comprehensive public health strategies addressing cardiovascular implications of marijuana consumption. As usage rises, particularly among younger populations, healthcare providers and policymakers must educate individuals about potential cardiovascular risks associated with different consumption methods. Further research is needed to elucidate mechanisms and inform future guidelines for CHD risk reduction.
{"title":"Exploring the Link: Marijuana Use Patterns and Their Impact on Coronary Heart Disease Risk","authors":"Tianwen Wei, Shitong Shen, Tiankai Shan, Tangjiang Wan, Yucheng Liang, Zhihao Lin, Yuxiao Sun, Yafei Li, Qi Zhang","doi":"10.1002/clc.70223","DOIUrl":"10.1002/clc.70223","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>As marijuana use increases globally, understanding its cardiovascular impact is crucial. This study investigates the relationship between marijuana use patterns and coronary heart disease (CHD) risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using 2023 Behavioral Risk Factor Surveillance System data, we conducted cross-sectional analysis examining marijuana consumption methods (smoking, vaping, eating, dabbing) and CHD risk. Multivariable logistic regression assessed associations while controlling for demographic variables and established cardiovascular risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significant associations emerged between various marijuana consumption methods and increased CHD risk. Individuals engaging in both smoking and vaping showed significantly higher CHD risk. Combined consumption methods, particularly smoking and eating, further compounded risk among those with pre-existing cardiovascular risk factors. Traditional risk factors including hypertension, diabetes, and obesity remained critical CHD predictors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study reveals complex relationships between marijuana use patterns and CHD risk, emphasizing the need for comprehensive public health strategies addressing cardiovascular implications of marijuana consumption. As usage rises, particularly among younger populations, healthcare providers and policymakers must educate individuals about potential cardiovascular risks associated with different consumption methods. Further research is needed to elucidate mechanisms and inform future guidelines for CHD risk reduction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 12","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70223","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mauricio Rigodanzo Mocha, Whady Hueb, Paulo Cury Rezende, Matheus de Oliveira Laterza Ribeiro, Thiago Luis Scudeler, Eduardo Gomes Lima, José Antonio Franchini Ramires, Roberto Kalil Filho
Background
Evaluation of percutaneous coronary intervention (PCI) effectiveness typically focuses on overall coronary events, often overlooking the specific location of these events within the coronary vasculature. This study aimed to evaluate the incidence of coronary events in patients treated with PCI and to investigate the correlation between these events, the location of the event within the treated site, and the type of stent used.
Methods
This study determined the proportion of coronary events occurring after percutaneous coronary intervention (PCI) and investigated the association between these events and the location of the previous treatment site. A retrospective cohort analysis was conducted on patients with stable coronary artery disease (CAD) who underwent PCI using either conventional or drug-eluting stents. Data was obtained from the MASS Clinical Research Unit database. The location of the coronary event was determined by angiography.
Results
Five hundred and sixty two patients were included, with 232 (41.3%) experiencing coronary events. 55.8% of the events occurred at the treated site, while the remaining 44.2% were unrelated to the treated site. Of the events related to the treated site, 54.1% occurred in the conventional stent group and 61.1% in the drug-eluting stent group. No statistically significant association was found between the event in the treated site and the type of stent used (p = 0.363).
Conclusions
A significant proportion of coronary events occurred in untreated sites. Our results suggest that isolated evaluation of the treated site may provide a more accurate estimate of the effectiveness of stents.
{"title":"Underestimation of Stent Efficacy: Untreated Artery Events Distort Coronary Intervention Outcomes","authors":"Mauricio Rigodanzo Mocha, Whady Hueb, Paulo Cury Rezende, Matheus de Oliveira Laterza Ribeiro, Thiago Luis Scudeler, Eduardo Gomes Lima, José Antonio Franchini Ramires, Roberto Kalil Filho","doi":"10.1002/clc.70229","DOIUrl":"10.1002/clc.70229","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Evaluation of percutaneous coronary intervention (PCI) effectiveness typically focuses on overall coronary events, often overlooking the specific location of these events within the coronary vasculature. This study aimed to evaluate the incidence of coronary events in patients treated with PCI and to investigate the correlation between these events, the location of the event within the treated site, and the type of stent used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study determined the proportion of coronary events occurring after percutaneous coronary intervention (PCI) and investigated the association between these events and the location of the previous treatment site. A retrospective cohort analysis was conducted on patients with stable coronary artery disease (CAD) who underwent PCI using either conventional or drug-eluting stents. Data was obtained from the MASS Clinical Research Unit database. The location of the coronary event was determined by angiography.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five hundred and sixty two patients were included, with 232 (41.3%) experiencing coronary events. 55.8% of the events occurred at the treated site, while the remaining 44.2% were unrelated to the treated site. Of the events related to the treated site, 54.1% occurred in the conventional stent group and 61.1% in the drug-eluting stent group. No statistically significant association was found between the event in the treated site and the type of stent used (<i>p</i> = 0.363).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A significant proportion of coronary events occurred in untreated sites. Our results suggest that isolated evaluation of the treated site may provide a more accurate estimate of the effectiveness of stents.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 12","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70229","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pan Yang, Zhixiang Ge, Liping Wang, Haiyan Ke, Min Xu
Objective
To assess left atrial (LA) structure and function in marathon runners using two-dimensional speckle tracking echocardiography (2D-STE) and real-time three-dimensional echocardiography (RT-3DE).
Methods
This study enrolled 50 healthy volunteers (control group) and 132 marathon runners, and collected their general information. 2D-STE and RT-3DE were performed to obtain LA structural and functional parameters and left ventricular mass index (LVMI). According to the LVMI criteria for diagnosing left ventricular hypertrophy (LVH), all marathon runners were divided into an LVMI normal group and an LVH group. A comparative analysis was performed among the three groups. Multivariate logistic regression was used to analyze the association, and curve fitting was used to show the change trends.
Results
Compared with the control group, LA total ejection fraction (LATEF) and LA passive ejection fraction (LAPEF) were higher in the LVMI normal group (p < 0.05). Compared with the control group and the LVMI normal group, LA maximal volume index (LAVImax), LA presystolic volume index (LAVIpre), and LA stiffness index (LASI) were higher in the LVH group, whereas LA reservoir strain (LASr), LA conduit strain (LAScd), and LA contraction strain (LASct) were lower (p < 0.05). Multivariate logistic regression analysis showed that LAVImax, LAScd, and LASct were significantly associated with LVH in marathon runners. Curve fitting showed that LAVImax increased with the increase of LVMI, whereas LAScd and LASct decreased.
Conclusion
2D-STE and RT-3DE can effectively assess LA structure and function in marathon runners. Marathon runners with normal LVMI exhibit normal LA structure and function, and even some functional enhancement, while those with LVH exhibit increased LA volume and decreased LA strain function.
{"title":"Two-Dimensional Speckle Tracking Echocardiography and Real-Time Three-Dimensional Echocardiography in Marathon Runners: A Study of Left Atrium","authors":"Pan Yang, Zhixiang Ge, Liping Wang, Haiyan Ke, Min Xu","doi":"10.1002/clc.70230","DOIUrl":"10.1002/clc.70230","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess left atrial (LA) structure and function in marathon runners using two-dimensional speckle tracking echocardiography (2D-STE) and real-time three-dimensional echocardiography (RT-3DE).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study enrolled 50 healthy volunteers (control group) and 132 marathon runners, and collected their general information. 2D-STE and RT-3DE were performed to obtain LA structural and functional parameters and left ventricular mass index (LVMI). According to the LVMI criteria for diagnosing left ventricular hypertrophy (LVH), all marathon runners were divided into an LVMI normal group and an LVH group. A comparative analysis was performed among the three groups. Multivariate logistic regression was used to analyze the association, and curve fitting was used to show the change trends.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared with the control group, LA total ejection fraction (LATEF) and LA passive ejection fraction (LAPEF) were higher in the LVMI normal group (<i>p</i> < 0.05). Compared with the control group and the LVMI normal group, LA maximal volume index (LAVImax), LA presystolic volume index (LAVIpre), and LA stiffness index (LASI) were higher in the LVH group, whereas LA reservoir strain (LASr), LA conduit strain (LAScd), and LA contraction strain (LASct) were lower (<i>p</i> < 0.05). Multivariate logistic regression analysis showed that LAVImax, LAScd, and LASct were significantly associated with LVH in marathon runners. Curve fitting showed that LAVImax increased with the increase of LVMI, whereas LAScd and LASct decreased.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>2D-STE and RT-3DE can effectively assess LA structure and function in marathon runners. Marathon runners with normal LVMI exhibit normal LA structure and function, and even some functional enhancement, while those with LVH exhibit increased LA volume and decreased LA strain function.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 12","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12670292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The prognostic impact of catheter ablation in patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) remains controversial. Using a nationwide database, the authors demonstrated that catheter ablation was associated with cardiovascular and cerebral benefits, as well as a reduction in all-cause mortality, in patients with AF and HFpEF [1]. Several concerns arise from these findings.
The authors assessed all-cause mortality in the HFpEF cohort, although the prescription rates of guideline-directed medical therapy—including sodium–glucose cotransporter-2 inhibitors—were extremely low [1]. This may limit the interpretation of mortality reduction attributable to catheter ablation itself.
The major causes of death in HFpEF are generally noncardiac [2]. The mechanism by which catheter ablation would reduce all-cause mortality in this population therefore remains unclear. Catheter ablation helps prevent thrombus formation and stroke, and may reduce worsening heart failure by preserving atrial contraction. However, it is unlikely to directly decrease noncardiac events, which represent a substantial proportion of deaths in HFpEF.
The authors excluded patients who underwent valve replacement [1]. Yet, one of the most advanced clinical scenarios of HFpEF with AF involves significant valvular disease—particularly mitral regurgitation—that requires intervention [3]. Including such patients would improve the generalizability of the findings to a more representative HFpEF population. Moreover, individuals with severe valvular disease often have markedly remodeled atria and are seldom considered for catheter ablation.
Another important issue not evaluated in this study is bleeding related to anticoagulant therapy [1]. Patients with HFpEF may be at higher risk of bleeding complications than those with reduced ejection fraction [4]. In this regard, we strongly recommend considering left atrial appendage closure at the time of catheter ablation to mitigate anticoagulant-related bleeding risk, if applicable.
{"title":"How to Assess the Impact of Catheter Ablation for Atrial Fibrillation in Patients With Heart Failure With Preserved Ejection Fraction","authors":"Naoya Kataoka, Teruhiko Imamura","doi":"10.1002/clc.70231","DOIUrl":"10.1002/clc.70231","url":null,"abstract":"<p>The prognostic impact of catheter ablation in patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) remains controversial. Using a nationwide database, the authors demonstrated that catheter ablation was associated with cardiovascular and cerebral benefits, as well as a reduction in all-cause mortality, in patients with AF and HFpEF [<span>1</span>]. Several concerns arise from these findings.</p><p>The authors assessed all-cause mortality in the HFpEF cohort, although the prescription rates of guideline-directed medical therapy—including sodium–glucose cotransporter-2 inhibitors—were extremely low [<span>1</span>]. This may limit the interpretation of mortality reduction attributable to catheter ablation itself.</p><p>The major causes of death in HFpEF are generally noncardiac [<span>2</span>]. The mechanism by which catheter ablation would reduce all-cause mortality in this population therefore remains unclear. Catheter ablation helps prevent thrombus formation and stroke, and may reduce worsening heart failure by preserving atrial contraction. However, it is unlikely to directly decrease noncardiac events, which represent a substantial proportion of deaths in HFpEF.</p><p>The authors excluded patients who underwent valve replacement [<span>1</span>]. Yet, one of the most advanced clinical scenarios of HFpEF with AF involves significant valvular disease—particularly mitral regurgitation—that requires intervention [<span>3</span>]. Including such patients would improve the generalizability of the findings to a more representative HFpEF population. Moreover, individuals with severe valvular disease often have markedly remodeled atria and are seldom considered for catheter ablation.</p><p>Another important issue not evaluated in this study is bleeding related to anticoagulant therapy [<span>1</span>]. Patients with HFpEF may be at higher risk of bleeding complications than those with reduced ejection fraction [<span>4</span>]. In this regard, we strongly recommend considering left atrial appendage closure at the time of catheter ablation to mitigate anticoagulant-related bleeding risk, if applicable.</p><p>The authors have nothing to report.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p><p>The authors have nothing to report.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 12","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12670290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>We read with great interest the recent article by Meunier et al. [<span>1</span>] reporting the 3-year follow-up of a prospective all-comers observational study evaluating a stentless percutaneous coronary intervention (PCI) strategy with drug-coated balloons (DCB). The authors are to be commended for providing one of the most comprehensive long-term datasets on this approach. Their findings, particularly the low rate of target lesion revascularization (TLR) in the DCB-only cohort (2.6%) compared with the bailout drug-eluting stent (DES) group (6%), underscore the feasibility of a “leave nothing behind” strategy in contemporary practice.</p><p>The rationale for DCB angioplasty rests on avoiding the long-term complications of permanent metallic scaffolds, including in-stent restenosis, neoatherosclerosis, and late thrombosis [<span>2</span>]. The durability of outcomes over 3 years in an unselected population provides important reassurance for interventional cardiologists considering wider adoption of a DCB-first approach.</p><p>However, the absence of randomization precludes firm causal inference. The differences in TLR-free survival (<i>p</i> = 0.016) may reflect lesion complexity or operator selection bias rather than an actual treatment effect. Randomized controlled trials directly comparing stentless PCI with current-generation DES are required to establish durability, safety, and generalizability [<span>3, 4</span>]. Such studies should also examine endpoints beyond TLR, including myocardial infarction, late thrombosis, and patient-reported outcomes.</p><p>Notably, the introduction of the “metal index” serves as a quantitative marker of stent burden. The observation that higher indices were associated with worse outcomes highlights their potential as a prognostic tool. Future research should validate the metal index in diverse cohorts and determine whether it can guide clinical decision-making, particularly when hybrid strategies necessitate bailout stenting.</p><p>Patient and lesion selection also remain critical considerations. While small-vessel disease, bifurcations, and high-bleeding-risk subsets have been the traditional focus of DCB angioplasty [<span>5</span>], the favorable long-term outcomes reported here suggest that the potential scope of patients who may benefit could be broader. Rigorous comparative studies, including registry-based analyses, will be essential to delineate these populations more precisely.</p><p>In summary, Meunier et al. provide compelling evidence that reinforces the biological and clinical appeal of a stentless PCI strategy, advancing the dialogue on the “leave nothing behind” paradigm. At the same time, their work should be viewed as a call to action: large-scale randomized trials are urgently needed to validate these observational insights, to explore the clinical utility of the metal index, and to define the optimal patient subsets for DCB-first strategies.</p><p><b>Hasnain Wajeeh Saqib:</b> writing –
{"title":"Leave Nothing Behind in Coronary Intervention: Time to Move From Promise to Proof","authors":"Hasnain Wajeeh Saqib, Talha Khan, Rehman Bashir, Tazeem Hayat, Areesha Ishfaq Ahmed, Ayesha Tariq","doi":"10.1002/clc.70228","DOIUrl":"10.1002/clc.70228","url":null,"abstract":"<p>We read with great interest the recent article by Meunier et al. [<span>1</span>] reporting the 3-year follow-up of a prospective all-comers observational study evaluating a stentless percutaneous coronary intervention (PCI) strategy with drug-coated balloons (DCB). The authors are to be commended for providing one of the most comprehensive long-term datasets on this approach. Their findings, particularly the low rate of target lesion revascularization (TLR) in the DCB-only cohort (2.6%) compared with the bailout drug-eluting stent (DES) group (6%), underscore the feasibility of a “leave nothing behind” strategy in contemporary practice.</p><p>The rationale for DCB angioplasty rests on avoiding the long-term complications of permanent metallic scaffolds, including in-stent restenosis, neoatherosclerosis, and late thrombosis [<span>2</span>]. The durability of outcomes over 3 years in an unselected population provides important reassurance for interventional cardiologists considering wider adoption of a DCB-first approach.</p><p>However, the absence of randomization precludes firm causal inference. The differences in TLR-free survival (<i>p</i> = 0.016) may reflect lesion complexity or operator selection bias rather than an actual treatment effect. Randomized controlled trials directly comparing stentless PCI with current-generation DES are required to establish durability, safety, and generalizability [<span>3, 4</span>]. Such studies should also examine endpoints beyond TLR, including myocardial infarction, late thrombosis, and patient-reported outcomes.</p><p>Notably, the introduction of the “metal index” serves as a quantitative marker of stent burden. The observation that higher indices were associated with worse outcomes highlights their potential as a prognostic tool. Future research should validate the metal index in diverse cohorts and determine whether it can guide clinical decision-making, particularly when hybrid strategies necessitate bailout stenting.</p><p>Patient and lesion selection also remain critical considerations. While small-vessel disease, bifurcations, and high-bleeding-risk subsets have been the traditional focus of DCB angioplasty [<span>5</span>], the favorable long-term outcomes reported here suggest that the potential scope of patients who may benefit could be broader. Rigorous comparative studies, including registry-based analyses, will be essential to delineate these populations more precisely.</p><p>In summary, Meunier et al. provide compelling evidence that reinforces the biological and clinical appeal of a stentless PCI strategy, advancing the dialogue on the “leave nothing behind” paradigm. At the same time, their work should be viewed as a call to action: large-scale randomized trials are urgently needed to validate these observational insights, to explore the clinical utility of the metal index, and to define the optimal patient subsets for DCB-first strategies.</p><p><b>Hasnain Wajeeh Saqib:</b> writing – ","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 12","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12670287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yang Gao, Qingbo Shi, Zhuocheng Shi, Zhiwen Zhang, Haosen Yu, Mingxing Lv, Tong Zhang, Donghui Chen, Yu shuo Gu, Quan Guo, Muwei Li, Cao Ma
Background
Insomnia is a prevalent sleep disorder increasingly recognized as a risk factor for cardiovascular diseases (CVDs). However, its causal relationship with myocardial infarction (MI) and its impact on coronary plaque vulnerability remain poorly understood.
Methods
We performed Mendelian randomization (MR) analysis using genome-wide association study (GWAS) summary data for insomnia (n = 462,341) and MI (n = 484,598) in populations of European descent. Additionally, 340 patients with coronary artery disease (CAD) underwent coronary angiography and optical coherence tomography (OCT) imaging. Insomnia was assessed by the Insomnia Severity Index (ISI), and OCT was used to evaluate plaque features including thin-cap fibroatheroma (TCFA), fibrous cap thickness, lipid arc, macrophage infiltration, and plaque rupture.
Results
MR analysis showed a potential causal effect of genetically predicted insomnia on MI risk (OR = 1.015; 95% CI: 1.004–1.027; p = 0.007), with no evidence of pleiotropy or heterogeneity. Clinically patients with insomnia (ISI ≥ 8) had higher rates of hypertension (54.3% vs. 39.6%) and MI (32.4% vs. 21.7%), elevated CRP levels, and exhibited greater plaque vulnerability on OCT, including increased incidence of TCFA (29.5% vs. 17.0%), thinner fibrous caps, larger lipid arcs, and more frequent macrophage infiltration and plaque rupture. Logistic regression identified both insomnia (OR = 1.806; p = 0.037) and CRP (OR = 1.384; p = 0.034) as independent predictors of TCFA.
Conclusions
This study provides genetic and clinical evidence that insomnia contributes to MI risk and coronary plaque vulnerability, underscoring the importance of addressing sleep disturbances in CAD management.
背景：失眠是一种普遍的睡眠障碍，越来越被认为是心血管疾病（cvd）的危险因素。然而，其与心肌梗死（MI）的因果关系及其对冠状动脉斑块易损性的影响仍知之甚少。方法：我们使用全基因组关联研究（GWAS）汇总数据对欧洲血统人群的失眠（n = 462,341）和心肌梗死（n = 484,598）进行孟德尔随机化（MR）分析。此外，340例冠心病（CAD）患者接受了冠状动脉造影和光学相干断层扫描（OCT）成像。通过失眠严重指数（ISI）评估失眠，并用OCT评估斑块特征，包括薄帽纤维粥样瘤（TCFA）、纤维帽厚度、脂质弧、巨噬细胞浸润和斑块破裂。结果：磁共振分析显示基因预测失眠对心肌梗死风险的潜在因果影响（OR = 1.015; 95% CI: 1.004-1.027; p = 0.007），无多效性或异质性证据。临床失眠患者（ISI≥8）高血压（54.3% vs. 39.6%）和心肌梗死（32.4% vs. 21.7%）的发生率较高，CRP水平升高，在OCT上表现出更大的斑块易损性，包括TCFA发生率增加（29.5% vs. 17.0%），纤维帽更薄，脂质弧更大，巨噬细胞浸润和斑块破裂更频繁。Logistic回归发现失眠（OR = 1.806; p = 0.037）和CRP （OR = 1.384; p = 0.034）是TCFA的独立预测因子。结论：本研究提供了遗传学和临床证据，表明失眠有助于心肌梗死风险和冠状动脉斑块易感性，强调了解决睡眠障碍在冠心病管理中的重要性。
{"title":"Impact of Insomnia on Myocardial Infarction Risk and Coronary Plaque Vulnerability: Insights From Mendelian Randomization and OCT Imaging","authors":"Yang Gao, Qingbo Shi, Zhuocheng Shi, Zhiwen Zhang, Haosen Yu, Mingxing Lv, Tong Zhang, Donghui Chen, Yu shuo Gu, Quan Guo, Muwei Li, Cao Ma","doi":"10.1002/clc.70226","DOIUrl":"10.1002/clc.70226","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Insomnia is a prevalent sleep disorder increasingly recognized as a risk factor for cardiovascular diseases (CVDs). However, its causal relationship with myocardial infarction (MI) and its impact on coronary plaque vulnerability remain poorly understood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed Mendelian randomization (MR) analysis using genome-wide association study (GWAS) summary data for insomnia (<i>n</i> = 462,341) and MI (<i>n</i> = 484,598) in populations of European descent. Additionally, 340 patients with coronary artery disease (CAD) underwent coronary angiography and optical coherence tomography (OCT) imaging. Insomnia was assessed by the Insomnia Severity Index (ISI), and OCT was used to evaluate plaque features including thin-cap fibroatheroma (TCFA), fibrous cap thickness, lipid arc, macrophage infiltration, and plaque rupture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>MR analysis showed a potential causal effect of genetically predicted insomnia on MI risk (OR = 1.015; 95% CI: 1.004–1.027; <i>p</i> = 0.007), with no evidence of pleiotropy or heterogeneity. Clinically patients with insomnia (ISI ≥ 8) had higher rates of hypertension (54.3% vs. 39.6%) and MI (32.4% vs. 21.7%), elevated CRP levels, and exhibited greater plaque vulnerability on OCT, including increased incidence of TCFA (29.5% vs. 17.0%), thinner fibrous caps, larger lipid arcs, and more frequent macrophage infiltration and plaque rupture. Logistic regression identified both insomnia (OR = 1.806; <i>p</i> = 0.037) and CRP (OR = 1.384; <i>p</i> = 0.034) as independent predictors of TCFA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study provides genetic and clinical evidence that insomnia contributes to MI risk and coronary plaque vulnerability, underscoring the importance of addressing sleep disturbances in CAD management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 12","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12670183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Micha T. Maeder, Alexander Breuss, Sharon Appert, Simon Wildermuth, Philipp K. Haager, Johannes Rigger, Joannis Chronis, Martin O. Schmiady, Hans Rickli, Lukas Weber
Background
Loop diuretic therapy (LDT) is associated with increased mortality in heart failure. Severe aortic stenosis (AS) patients are at risk for heart failure and frequently on LDT. We assessed cardiac structure and function, organ congestion, filling pressures, and long-term outcomes of severe AS patients on LDT undergoing aortic valve replacement (AVR).
Methods
Consecutive patients with severe AS with [n = 157; median (interquartile range) daily torasemide dose: 10 (5–15) mg] or without (n = 346) LDT undergoing a detailed assessment of congestion (B-type natriuretic peptide, liver enzymes, systematic chest X-ray analysis) and cardiac catheterization before AVR with a post-AVR follow-up of several years were studied.
Results
Despite similar AS severity (indexed aortic valve area 0.41 ± 0.12 vs. 0.43 ± 0.12 cm2/m2) patients with LDT had more advanced biventricular remodeling and dysfunction, higher B-type natriuretic peptide [446 (245–991) vs. 150 (62–317) ng/L; p < 0.001], higher liver enzymes, higher chest x-ray congestion score [2 (1–4.5) vs. 1 (0–2) score points; p < 0.001], and higher mean right atrial pressure (8 ± 4 vs. 6 ± 3 mmHg) and mean pulmonary artery wedge pressure (21 ± 8 vs. 14 ± 6 mmHg; p < 0.001 for both) than those without. After a median post-AVR follow-up of 15 months functional capacity was worse, and estimated systolic pulmonary pressure was higher (37 ± 11 vs. 32 ± 8 mmHg; p < 0.001), and after a median follow-up of 44 months mortality was higher [hazard ratio 2.01 (95% confidence interval 1.17–3.77); p = 0.01] in LDT compared to non-LDT patients.
Conclusions
LDT identifies AS patients with more advanced cardiac remodeling, more severe congestion, unfavorable hemodynamics, impaired post-AVR status, and increased post-AVR long-term mortality.
{"title":"Loop Diuretic Therapy in Severe Aortic Stenosis: Marker of Organ Congestion, Unfavorable Hemodynamics, and Increased Post-Valve Replacement Mortality","authors":"Micha T. Maeder, Alexander Breuss, Sharon Appert, Simon Wildermuth, Philipp K. Haager, Johannes Rigger, Joannis Chronis, Martin O. Schmiady, Hans Rickli, Lukas Weber","doi":"10.1002/clc.70225","DOIUrl":"https://doi.org/10.1002/clc.70225","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Loop diuretic therapy (LDT) is associated with increased mortality in heart failure. Severe aortic stenosis (AS) patients are at risk for heart failure and frequently on LDT. We assessed cardiac structure and function, organ congestion, filling pressures, and long-term outcomes of severe AS patients on LDT undergoing aortic valve replacement (AVR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive patients with severe AS with [<i>n</i> = 157; median (interquartile range) daily torasemide dose: 10 (5–15) mg] or without (<i>n</i> = 346) LDT undergoing a detailed assessment of congestion (B-type natriuretic peptide, liver enzymes, systematic chest X-ray analysis) and cardiac catheterization before AVR with a post-AVR follow-up of several years were studied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Despite similar AS severity (indexed aortic valve area 0.41 ± 0.12 vs. 0.43 ± 0.12 cm<sup>2</sup>/m<sup>2</sup>) patients with LDT had more advanced biventricular remodeling and dysfunction, higher B-type natriuretic peptide [446 (245–991) vs. 150 (62–317) ng/L; <i>p</i> < 0.001], higher liver enzymes, higher chest x-ray congestion score [2 (1–4.5) vs. 1 (0–2) score points; <i>p</i> < 0.001], and higher mean right atrial pressure (8 ± 4 vs<i>.</i> 6 ± 3 mmHg) and mean pulmonary artery wedge pressure (21 ± 8 vs. 14 ± 6 mmHg; <i>p</i> < 0.001 for both) than those without. After a median post-AVR follow-up of 15 months functional capacity was worse, and estimated systolic pulmonary pressure was higher (37 ± 11 vs<i>.</i> 32 ± 8 mmHg; <i>p</i> < 0.001), and after a median follow-up of 44 months mortality was higher [hazard ratio 2.01 (95% confidence interval 1.17–3.77); <i>p</i> = 0.01] in LDT compared to non-LDT patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LDT identifies AS patients with more advanced cardiac remodeling, more severe congestion, unfavorable hemodynamics, impaired post-AVR status, and increased post-AVR long-term mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 12","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70225","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>The recent systematic review and meta-analysis by Yasmin et al. addressing immediate versus staged revascularization of non-culprit arteries in patients with acute coronary syndrome (ACS) and multivessel disease offers timely and clinically relevant insights [<span>1</span>]. While their work advances the field, several important considerations remain under explored and warrant further attention.</p><p>Procedural complexity is an underappreciated determinant of outcomes. Immediate multivessel intervention often entails longer procedural duration, higher fluoroscopy exposure, and greater operator workload factors rarely captured in randomized trials. These elements are directly linked to complication rates and periprocedural safety. Contemporary evidence demonstrates that operator experience and intravascular imaging improve long-term outcomes in complex PCI, underscoring the importance of workload and expertise as modifiers of risk [<span>2</span>].</p><p>Renal outcomes also deserve greater emphasis. Although the authors note the potential for contrast-induced nephropathy, their analysis does not account for cumulative contrast burden or the possibility of renal recovery between staged procedures. Observational studies have established that contrast volume is a strong predictor of acute kidney injury and adverse prognosis, particularly in patients with impaired baseline renal function [<span>3, 4</span>]. Pooled analyses that omit this dimension may underestimate renal risk associated with either strategy.</p><p>Economic and resource implications are highly relevant but absent from the analysis. Differences in hospital length of stay, catheterization laboratory occupancy, and downstream costs carry meaningful consequences for patients and health systems. Prior studies indicate that staged PCI is associated with higher cumulative costs compared with one-time complete revascularization [<span>5</span>]. These considerations are particularly salient for resource-limited settings where system efficiency influences real-world adoption.</p><p>Physiologic lesion assessment is another key omission. The landmark FAME trial demonstrated that fractional flow reserve (FFR)-guided PCI reduces unnecessary stenting and improves outcomes [<span>6</span>]. Current European guidelines endorse physiology-guided revascularization whenever feasible [<span>7</span>]. Staged procedures allow for reassessment with FFR or instantaneous wave-free ratio following stabilization, which may enhance the appropriateness of intervention and reduce overtreatment.</p><p>Finally, operator and institutional expertise are well-recognized determinants of PCI outcomes. Large registries confirm that both operator volume and the use of intravascular imaging independently improve results [<span>2</span>]. Failure to stratify outcomes by these variables limits generalizability across diverse practice environments.</p><p>In conclusion, while the work by Yasmin et al. contributes signific
{"title":"Nuanced Considerations in Immediate Versus Staged Multivessel PCI: Implications for Clinical Practice and Guideline Development","authors":"Hassan E Muhammad, Samia Nawaz","doi":"10.1002/clc.70224","DOIUrl":"https://doi.org/10.1002/clc.70224","url":null,"abstract":"<p>The recent systematic review and meta-analysis by Yasmin et al. addressing immediate versus staged revascularization of non-culprit arteries in patients with acute coronary syndrome (ACS) and multivessel disease offers timely and clinically relevant insights [<span>1</span>]. While their work advances the field, several important considerations remain under explored and warrant further attention.</p><p>Procedural complexity is an underappreciated determinant of outcomes. Immediate multivessel intervention often entails longer procedural duration, higher fluoroscopy exposure, and greater operator workload factors rarely captured in randomized trials. These elements are directly linked to complication rates and periprocedural safety. Contemporary evidence demonstrates that operator experience and intravascular imaging improve long-term outcomes in complex PCI, underscoring the importance of workload and expertise as modifiers of risk [<span>2</span>].</p><p>Renal outcomes also deserve greater emphasis. Although the authors note the potential for contrast-induced nephropathy, their analysis does not account for cumulative contrast burden or the possibility of renal recovery between staged procedures. Observational studies have established that contrast volume is a strong predictor of acute kidney injury and adverse prognosis, particularly in patients with impaired baseline renal function [<span>3, 4</span>]. Pooled analyses that omit this dimension may underestimate renal risk associated with either strategy.</p><p>Economic and resource implications are highly relevant but absent from the analysis. Differences in hospital length of stay, catheterization laboratory occupancy, and downstream costs carry meaningful consequences for patients and health systems. Prior studies indicate that staged PCI is associated with higher cumulative costs compared with one-time complete revascularization [<span>5</span>]. These considerations are particularly salient for resource-limited settings where system efficiency influences real-world adoption.</p><p>Physiologic lesion assessment is another key omission. The landmark FAME trial demonstrated that fractional flow reserve (FFR)-guided PCI reduces unnecessary stenting and improves outcomes [<span>6</span>]. Current European guidelines endorse physiology-guided revascularization whenever feasible [<span>7</span>]. Staged procedures allow for reassessment with FFR or instantaneous wave-free ratio following stabilization, which may enhance the appropriateness of intervention and reduce overtreatment.</p><p>Finally, operator and institutional expertise are well-recognized determinants of PCI outcomes. Large registries confirm that both operator volume and the use of intravascular imaging independently improve results [<span>2</span>]. Failure to stratify outcomes by these variables limits generalizability across diverse practice environments.</p><p>In conclusion, while the work by Yasmin et al. contributes signific","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 12","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70224","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145595352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hypertension often coexists with dyslipidemia, requiring combination therapy. Telmisartan, combined with amlodipine or rosuvastatin, targets these conditions. This meta-analysis evaluates the efficacy and safety of these combinations in adults with hypertension and dyslipidemia.
Methods
A systematic search was conducted in Cochrane Central, MEDLINE/PubMed, ClinicalTrials.gov, and ScienceDirect (as of June 2024) for randomized controlled trials (RCTs) comparing telmisartan plus amlodipine versus telmisartan plus rosuvastatin in adults (≥ 18 years) with hypertension and dyslipidemia. A random-effects model was used with RevMan 5.4.1. The risk of bias and heterogeneity were assessed with the Cochrane Risk of Bias Tool and the I² statistic.
Results
Three RCTs involving 320 participants were included. At 4 weeks, telmisartan + amlodipine yielded greater sSBP (sitting Systolic Blood Pressure) reduction compared to telmisartan + rosuvastatin (MD = −10.93 mmHg; 95% CI: −19.02 to −2.83; p = 0.008; I² = 70%). sDBP (sitting Diastolic Blood Pressure) reductions were greater in the amlodipine group at 8 weeks (MD = −8.59 mmHg; 95% CI: −13.35 to −3.82; p = 0.0004; I² = 58%). Conversely, LDL-C reduction was favored by telmisartan + rosuvastatin, with significant effects observed at both 4 weeks (MD = 85.98 mg/dL) and 8 weeks (MD = 79.75 mg/dL). TEAE incidence did not differ significantly (RR = 1.23; 95% CI: 0.75–2.04; p = 0.41; I² = 0%).
Conclusion
Telmisartan + amlodipine demonstrates superior antihypertensive efficacy, while telmisartan + rosuvastatin more effectively lowers LDL-C. Safety profiles are comparable. Findings support the selection of a regimen based on individualized therapeutic goals.
{"title":"Dual-Targeted Therapy in Cardiometabolic Risk: A Meta-Analysis of Telmisartan-Based Combinations for Hypertension and Dyslipidemia","authors":"Rabia Asim, Tazheen Saleh Muhammad, Saad Ahmed, Laiba Khurram, Bazil Azeem, Mata-e-Alla Doggar, Abdullah Naveed Muhammad, Rahul Chikatimalla, Sowjanya Kapaganti, Himaja Dutt Chigurupati, Binish Qureshi, Harigopal Sandhyavenu, Sivaram Neppala","doi":"10.1002/clc.70211","DOIUrl":"https://doi.org/10.1002/clc.70211","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hypertension often coexists with dyslipidemia, requiring combination therapy. Telmisartan, combined with amlodipine or rosuvastatin, targets these conditions. This meta-analysis evaluates the efficacy and safety of these combinations in adults with hypertension and dyslipidemia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search was conducted in Cochrane Central, MEDLINE/PubMed, ClinicalTrials.gov, and ScienceDirect (as of June 2024) for randomized controlled trials (RCTs) comparing telmisartan plus amlodipine versus telmisartan plus rosuvastatin in adults (≥ 18 years) with hypertension and dyslipidemia. A random-effects model was used with RevMan 5.4.1. The risk of bias and heterogeneity were assessed with the Cochrane Risk of Bias Tool and the <i>I</i>² statistic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three RCTs involving 320 participants were included. At 4 weeks, telmisartan + amlodipine yielded greater sSBP (sitting Systolic Blood Pressure) reduction compared to telmisartan + rosuvastatin (MD = −10.93 mmHg; 95% CI: −19.02 to −2.83; <i>p</i> = 0.008; <i>I</i>² = 70%). sDBP (sitting Diastolic Blood Pressure) reductions were greater in the amlodipine group at 8 weeks (MD = −8.59 mmHg; 95% CI: −13.35 to −3.82; <i>p</i> = 0.0004; <i>I</i>² = 58%). Conversely, LDL-C reduction was favored by telmisartan + rosuvastatin, with significant effects observed at both 4 weeks (MD = 85.98 mg/dL) and 8 weeks (MD = 79.75 mg/dL). TEAE incidence did not differ significantly (RR = 1.23; 95% CI: 0.75–2.04; <i>p</i> = 0.41; <i>I</i>² = 0%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Telmisartan + amlodipine demonstrates superior antihypertensive efficacy, while telmisartan + rosuvastatin more effectively lowers LDL-C. Safety profiles are comparable. Findings support the selection of a regimen based on individualized therapeutic goals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 12","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70211","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145595353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
John W. Davis, Steven L. Mai, Wissam Harmouch, Jenna Reisler, Micaela MacKay, Elizabeth Davis, Pavel Osmancik, Michael W. Rich
Introduction
Atrial fibrillation-related stroke is a leading cause of morbidity and mortality. The comparative effectiveness and safety of left atrial appendage closure (LAAC) devices, compared with one another and with anticoagulation, is unclear.
Methods
We conducted a systematic review and network meta-analysis (NMA) of all clinical trials comparing the Watchman and Amplatzer Amulet LAAC devices with each other or with warfarin or direct oral anticoagulants (DOACs). The primary comparison was between LAAC devices with secondary comparisons to anticoagulation. The primary effectiveness outcomes were any stroke and all-cause death. Safety outcomes included any thromboembolism, device embolization, and pericardial effusion.
Results
There were 476 articles identified from the search and 6 eligible RCTs were included (n = 3666). There was no difference in the risk of stroke with Amulet versus Watchman (RR = 1.48, 95% CI: 0.64–3.46, I2 = 41.3%), nor in the risk of death (RR = 1.00, 95% CI: 0.59–1.70, I2 = 45.0%). Risk of thromboembolism was not significantly different with Amulet versus Watchman (RR = 0.73, 95% CI: 0.18–2.97, I2 = 0%), nor was risk of device embolization (RR = 2.29, 95% CI: 0.71, 7.43, I2 = 0%). Both devices exhibited increased risk of pericardial effusion compared with warfarin, with Amulet at highest relative risk (RR = 27.08, 95% CI: 3.53–207.98, I2 = 0%) followed by Watchman (RR = 12.79, 95% CI: 1.73–94.85, I2 = 0%). Amulet also carried higher relative risk of pericardial effusion than Watchman (RR = 2.12, 95% CI: 1.45–3.09).
Conclusion
In this NMA, the Amulet and Watchman LAAC devices were associated with similar risks for stroke, mortality, thromboembolism, and device embolization. Pericardial effusion risk was higher with Amulet than Watchman.
{"title":"Comparing Effectiveness and Safety of Left Atrial Appendage Closure Devices: A Network Meta-Analysis of Randomized Controlled Trials","authors":"John W. Davis, Steven L. Mai, Wissam Harmouch, Jenna Reisler, Micaela MacKay, Elizabeth Davis, Pavel Osmancik, Michael W. Rich","doi":"10.1002/clc.70217","DOIUrl":"10.1002/clc.70217","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Atrial fibrillation-related stroke is a leading cause of morbidity and mortality. The comparative effectiveness and safety of left atrial appendage closure (LAAC) devices, compared with one another and with anticoagulation, is unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic review and network meta-analysis (NMA) of all clinical trials comparing the Watchman and Amplatzer Amulet LAAC devices with each other or with warfarin or direct oral anticoagulants (DOACs). The primary comparison was between LAAC devices with secondary comparisons to anticoagulation. The primary effectiveness outcomes were any stroke and all-cause death. Safety outcomes included any thromboembolism, device embolization, and pericardial effusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 476 articles identified from the search and 6 eligible RCTs were included (<i>n</i> = 3666). There was no difference in the risk of stroke with Amulet versus Watchman (RR = 1.48, 95% CI: 0.64–3.46, <i>I</i><sup>2</sup> = 41.3%), nor in the risk of death (RR = 1.00, 95% CI: 0.59–1.70, <i>I</i><sup>2</sup> = 45.0%). Risk of thromboembolism was not significantly different with Amulet versus Watchman (RR = 0.73, 95% CI: 0.18–2.97, <i>I</i><sup>2</sup> = 0%), nor was risk of device embolization (RR = 2.29, 95% CI: 0.71, 7.43, <i>I</i><sup>2</sup> = 0%). Both devices exhibited increased risk of pericardial effusion compared with warfarin, with Amulet at highest relative risk (RR = 27.08, 95% CI: 3.53–207.98, <i>I</i><sup>2</sup> = 0%) followed by Watchman (RR = 12.79, 95% CI: 1.73–94.85, <i>I</i><sup>2</sup> = 0%). Amulet also carried higher relative risk of pericardial effusion than Watchman (RR = 2.12, 95% CI: 1.45–3.09).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this NMA, the Amulet and Watchman LAAC devices were associated with similar risks for stroke, mortality, thromboembolism, and device embolization. Pericardial effusion risk was higher with Amulet than Watchman.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 11","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70217","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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